• Impact on Practice

      Lovell, Andy; University of Chester (EMAP, 2018-02-01)
      An article discussing the difficulties that professionals, particularly nurses, have when undertaking doctoral studies, because of managerial perceptions of how their work might have an impact on practice and the tension this sometimes creates.
    • Inadequate dried blood spot samples for Early Infant Diagnosis, how common and what are the reasons for rejection in Zimbabwe?

      Chiku, Charles; Zolfo, Maria; Senkoro, Mbazi; Mabhala, Mzwandile A.; Tweya, Hannock; Musasa, Patience; Shukusho, Fungai D.; Mazarura, Exervia; Mushavi, Angela; Mangwanya, Douglas; et al. (PLoS, 2019-08-31)
      Background Early infant diagnosis (EID) of HIV in infants provides an opportunity for early detection of the infection and early access to Antiretroviral treatment (ART). Dried Blood Spot (DBS) samples are used for EID of HIV-exposed infants, born from HIV positive mothers. However, DBS rejection rates have been exceeding in Zimbabwe the target of less than 2% per month set by the National Microbiology Reference Laboratory (NMRL). The aim of this study was to determine the DBS samples rejection rate, the reasons for rejection and the possible associations between rejection and level of health facility where the sample was collected. Methods Analytic cross-sectional study using routine DBS samples data from the NMRL in Harare, Zimbabwe, between January and December 2017. Results A total of 34.950 DBS samples were received at the NMRL. Of these, 1291(4%) were rejected and reasons for rejections were: insufficient specimen volume (72%), missing request form (11%), missing sample (6%), cross contamination (6%), mismatch information (4%) and clotted sample (1%). Samples collected from clinics/rural health facilities had five times likelihood to be rejected compared to those from a central hospital. Conclusion Rejection rates were above the set target of 2%. The reasons for rejection were ‘pre-analytical’ errors including labeling errors, sample damage, missing or inconsistent data, and insufficient volume. Samples collected at primary healthcare facilities had higher rejection rates.
    • Including public health considerations in trade and investment agreements

      Thow, A; Garde, A; Mabhala, M; Smith, R; Kingston, P; Manning, P; Hunter, D; Winters, L A; Lincoln, P; Parish, R (Oxford University Press (OUP), 2020-09-30)
      Abstract There is widespread recognition that trade and investment agreements (TIAs) can affect health services, access to medicines, NCD prevention (particularly related to tobacco, alcohol and unhealthy food) and health systems structures. In addition, these binding international economic agreements can constrain the policy space available for innovative, evidence-based health policymaking. Although TIAs can have positive outcomes for employment and economic growth, these benefits are only likely to accrue when governments are pro-active in implementing complementary policies to mitigate impacts on other sectors and to address potential inequalities arising. The aim of this panel session is to examine the ways in which TIAs can be designed to achieve economic goals while also protecting public health, and identify complementary policy measures that may be needed as well as strategies for strategic policy engagement. This panel will be hosted by the UK-PRP PETRA Network (Prevention of noncommunicable disease using trade agreements). The UK will be negotiating a range of new TIAs over the coming years, representing a window of opportunity for strategic engagement with policymakers regarding how public health can be protected and promoted within these agreements. There is an emerging global body of evidence regarding how consideration of health can be integrated into TIAs, both textually and through strategic engagement with policymakers before and during the negotiation phase. Experience to date indicates common global challenges and opportunities for health and trade, as well as significant potential for cross country learning regarding trade and health. The panel discussion will use the UK experience as a springboard to address these global issues.
    • Inhibitor clinical burden of disease: a comparative analysis of the CHESS data.

      Oladapo, Abiola; Lu, Mei; Walsh, Shaun; O'Hara, Jamie; Kauf, Teresa L. (2018-11-09)
      BACKGROUND:Patients with hemophilia and inhibitors generally face greater disease burden compared to patients without inhibitors. While raising awareness of relative burden may improve the standard of care for patients with inhibitors, comparative data are sparse. Analyzing data drawn from the Cost of Haemophilia across Europe - a Socioeconomic Survey (CHESS) study, the aim of this study was to compare the clinical burden of disease in patients with severe hemophilia with and without inhibitors. Hemophilia specialists (N = 139) across five European countries completed an online survey between January-April 2015, providing demographic, clinical and 12-month ambulatory/secondary care activity data for 1285 patients. Patients with hemophilia who currently presented with inhibitors and those who never had inhibitors were matched on baseline characteristics via propensity score matching. Outcomes were compared between the two cohorts using a paired t-test or Wilcoxon signed-rank or McNemar's test. RESULTS:The proportion of patients who currently presented with inhibitors was 4.5% (58/1285). Compared to PS-matched patients without inhibitors, patients with inhibitors experienced more than twice the mean annual number of bleeds (mean ± standard deviation, 8.29 ± 9.18 vs 3.72 ± 3.95; p < .0001) and joint bleeds (2.17 ± 1.90 vs 0.98 ± 1.15; p < .0001), and required more hemophilia-related (mean ± standard deviation, 1.79 ± 1.83 vs 0.64 ± 1.13) and bleed-related hospitalizations (1.86 ± 1.88 vs 0.81 ± 1.26), hemophilia-related consultations (9.30 ± 4.99 vs 6.77 ± 4.47), and outpatient visits (22.09 ± 17.77 vs 11.48 ± 16.00) (all, p < .001). More than one-half (53.5%) experienced moderate/severe pain necessitating medication compared to one-third (32.8%) of patients without inhibitors (p = .01). CONCLUSIONS:Patients with hemophilia and inhibitors exhibited greater clinical burden and higher resource utilization compared to their peers without inhibitors. Strategies for improving the standard of care may alleviate burden in this population.
    • Intellectual disability and autism: A life history approach to understanding self-injury

      Lovell, Andy; Skellern, Joanne; University of Chester (NOVA Publishers, 2012-07-25)
      This chapter relates to a qualitative research study into the lives of a number of individuals with intellectual disabilities and a propensity for self-injury.
    • Intellectual disability and violence: Conclusions from a trilogy of projects

      Skellern, Joanne; Lovell, Andy; University of Chester (Kavanah, 2011-10)
      This conference paper discusses a series of studies undertaken between 2007 and 2011 exploring different dimensions of the relationship between intellectual disability and violence.
    • Interaction between Metabolic Genetic Risk Score and Dietary Fatty Acid Intake on Central Obesity in a Ghanaian Population

      Alsulami, Sooad; Nyakotey, David; Dudek, Kamila; Bawah, Abdul-Malik; Lovegrove, Julie; Annan, Reggie; Ellahi, Basma; Karani, Santhanakrishnan Vimaleswaran; University of Reading, University of Chester and Kumasi University (MDPI, 2020-07-27)
      Obesity is a multifactorial condition arising from the interaction between genetic and lifestyle factors. We aimed to assess the impact of lifestyle and genetic factors on obesity-related traits in 302 healthy Ghanaian adults. Dietary intake and physical activity were assessed using a 3 day repeated 24 h dietary recall and global physical activity questionnaire, respectively. Twelve single nucleotide polymorphisms (SNPs) were used to construct 4-SNP, 8-SNP and 12-SNP genetic risk scores (GRSs). The 4-SNP GRS showed significant interactions with dietary fat intakes on waist circumference (WC) (Total fat, Pinteraction = 0.01; saturated fatty acids (SFA), Pinteraction = 0.02; polyunsaturated fatty acids (PUFA), Pinteraction = 0.01 and monounsaturated fatty acids (MUFA), Pinteraction = 0.01). Among individuals with higher intakes of total fat (>47 g/d), SFA (>14 g/d), PUFA (>16 g/d) and MUFA (>16 g/d), individuals with ≥3 risk alleles had a significantly higher WC compared to those with <3 risk alleles. This is the first study of its kind in this population, suggesting that a higher consumption of dietary fatty acid may have the potential to increase the genetic susceptibility of becoming centrally obese. These results support the general dietary recommendations to decrease the intakes of total fat and SFA, to reduce the risk of obesity, particularly in individuals with a higher genetic predisposition to central obesity.
    • Interaction between TCF7L2 polymorphism and dietary fat intake on high density lipoprotein cholesterol

      Bodhini, Dhanasekaran; Gaal, Szilvia; Shatwan, Israa M.; Ramya, Kandaswamy; Ellahi, Basma; Surendran, Shelini; Sudha, Vasudevan; Anjana, Mohan R.; Mohan, Viswanathan; Lovegrove, Julie A.; et al. (Public Library of Science, 2017-11-28)
      Recent evidence suggests that lifestyle factors influence the association between the Melanocortin 4 receptor (MC4R) and Transcription Factor 7-Like 2 (TCF7L2) gene variants and cardio-metabolic traits in several populations; however, the available research is limited among the Asian Indian population. Hence, the present study examined whether the association between the MC4R single nucleotide polymorphism (SNP) (rs17782313) and two SNPs of the TCF7L2 gene (rs12255372 and rs7903146) and cardio-metabolic traits is modified by dietary factors and physical activity. This cross sectional study included a random sample of normal glucose tolerant (NGT) (n=821) and participants with type 2 diabetes (T2D) (n=861) recruited from the urban part of the Chennai Urban Rural Epidemiology Study (CURES). A validated food frequency questionnaire (FFQ) was used for dietary assessment and self-reported physical activity measures were collected. The threshold for significance was set at P=0.00023 based on Bonferroni correction for multiple testing [(0.05/210 (3 SNPs x 14 outcomes x 5 lifestyle factors)]. After Bonferroni correction, there was a significant interaction between the TCF7L2 rs12255372 SNP and fat intake (g/day) (Pinteraction=0.0001) on high-density lipoprotein cholesterol (HDL-C), where the ‘T’ allele carriers in the lowest tertile of total fat intake had higher HDL-C (P=0.008) and those in the highest tertile (P=0.017) had lower HDL-C compared to the GG homozygotes. In a secondary analysis of SNPs with the subtypes of fat, there was also a significant interaction between the SNP rs12255372 and polyunsaturated fatty acids (PUFA, g/day) (Pinteraction<0.0001) on HDL-C, where the minor allele carriers had higher HDL-C in the lowest PUFA tertile (P=0.024) and those in the highest PUFA tertile had lower HDL-C (P=0.028) than GG homozygotes. In addition, a significant interaction was also seen between TCF7L2 SNP rs12255372 and fibre intake (g/day) on HDL-C (Pinteraction<0.0001). None of the other interactions between the SNPs and lifestyle factors were statistically significant after correction for multiple testing. Our findings indicate that the association between TCF7L2 SNP rs12255372 and HDL-C may be modified by dietary fat intake in this Asian Indian population.
    • Introduction

      Harlow, Elizabeth; University of Chester (Whiting & Birch, 2011-08-05)
    • Introduction - "How to write well: for students of health and social care"

      Keeling, June J.; Williams, Julie; Chapman, Hazel M.; University of Chester (McGraw-Hill / Open University Press, 2013-09-03)
      The aim of this book is to demystify academic writing for undergraduate students in health and social care education. You are probably required to submit several assignments throughout your programme of study, which may take different formats such as a written essay, a poster or a dissertation. The allocation of marks for your assignments will be primarily dependent upon two factors: content and academic writing. This book focuses on the many aspects that impact on the quality of academic writing and will help you to develop the essential skills required for your undergraduate level study and to achieve success. Academic writing is a skill that develops with practice and therefore the book takes you through a step-by-step guide of how to improve your academic writing, thereby enabling you to improve your own writing skills.
    • Introduction to Pharmacodynamics

      Robertson, Deborah A. F.; University of Chester (Mark Allen Healthcare Ltd, 2017-04-16)
      In this second article in the series of ‘bite sized’ pharmacology we will start to look at the principles of pharmacodynamics. It is important that prescribers are aware of the actions their drugs have in the body after administration. They should know the SITE of action (where the drug works), the MODE of action (how the drug works) and the time to ONSET and DURATION of action (when the drug starts to work and how long for). This helps prescribers decide on drug choice, drug dose and the dose schedule as well as the length of time the drug needs to be prescribed for. This knowledge can also assist the prescriber in prediction and prevention (or minimising) of adverse drug reactions and to help educate their patients on possible side effects. In this article we will look at SITEs of action; receptors, ion channels, enzymes, and transport systems. We will also introduce the concepts of agonism and antagonism and their relationship to MODE of action.
    • Introduction to Pharmacokinetics

      Robertson, Deborah A. F.; University of Chester (Mark Allen Healthcare Ltd, 2017-03-16)
      Pharmacology is an area many nurse prescribers tell me that they worry about. This is whether they are prescribing students or qualified prescribers. They are very aware of the importance of pharmacological knowledge and its impact on safe prescribing. They typically want to know how much information they need to know and what depth and breadth that information should take. Another area they worry about is how many drugs they need to be familiar with? This series of pharmacology articles will explore some concepts in pharmacology to support the prescriber in developing that knowledge. This article begins by examining the basic concepts of pharmacokinetics to allow the reader to improve their understanding of drug handling within the body. It will explore the processes of absorption, distribution, metabolism and excretion to chart a drugs ‘route’ from administration to elimination.
    • An introduction to problem based learning

      McCarthy, Jill (2007-06-01)
      This presentation discusses problem based learning (PBL) which is a style of facilitating learning in which the problem acts as the context and driving force for the knowledge to be learnt. PBL varies from problem solving in that with problem solving the students gain the knowledge and then apply it to the problem given, whereas with PBL, the problems are encountered before all the relevant knowledge has been acquired. It is claimed that a PBL approach produces indepdent, motivated students, with a deeper understanding of the subject and with improvements in communication, team work and higher order cognitive skills such as problem solving, and critical analysis.
    • Investigation of the development of a 'career' of aggressive behaviour by people with learning disabilities

      Lovell, Andy; Skellern, Joanne; University of Chester (Kavanah, 2010)
      This paper aims to study the development of aggression over time in the lives of a group of individuals with learning difficulties.
    • Involving Fathers in maternity care: Best practice

      Steen, Mary; Downe, Soo; Rigby, Katrina; Fisher, Duncan; Burgess, Adrienne; Davies, Jeremy; Leeds Teaching Hospitals NHS Trust ; UCLan ; Fatherhood Institute (2008-11-19)
      This presentation described and discussed a structured review of the evidence to support best practice when involving fathers during pregnancy, birth and following birth.
    • Is living well with dementia a credible aspiration for spousal carers?

      Tolhurst, Edward; Carey, Malcolm; Weicht, Bernhard; Kingston, Paul; Stafford University; University of Chester; University of Innsbruck (Taylor & Francis, 2018-05-21)
      In England there has been substantial policy development and an academic drive to promote the goal of ‘living well’ for people with dementia and their family members. This article critically evaluates the feasibility of this intention, with reference to the experience of those caring for people with the condition. Qualitative data are utilised from a study which explored how couples negotiate relationships and care. The focus of this paper is the perspectives of spousal carers and the challenges they encounter within their caring role. Views were obtained via semi-structured joint interviews where the carer participated alongside the person with dementia. The extent to which living well with dementia is a credible aspiration for carers is examined via three themes: identity subsumed under care responsibilities; the couple as an isolated family unit; and barriers to professional support. The findings highlight that experience of caring is highly complex and fraught with multiple practical, emotional and moral pressures. It is asserted that research into dementia and care relationships must avoid a zero sum situation, prompted by living well discourses, where attempts to bolster the position of people with dementia compound the marginalisation and stigmatisation of informal carers.
    • The issues affecting mental health nursing in Uganda

      Bailey, Jan; University of Chester (OMICS Group International, 2014-09-30)
      Estimates are that up to 35% of the Ugandan populations have a mental health condition; however access to psychiatric care, particularly for people living in rural areas, is poor. Additionally, cultural and lay beliefs and stigma affect both the individual with mental illness and healthcare professionals. The Ugandan government has recognized the need to modernize legislation and develop policies designed to provide modern psychiatric services to the whole population. Strategies include, passing new legislation, integrating services into primary care, including psychiatric illness in nurse education. Nevertheless, evidence suggests that this rhetoric is not being fully enacted. This paper reviews the issues affecting the development and delivery of improved mental health services, with a particular focus on psychiatric nursing. Actions that have already successfully addressed issues with psychiatric services in Uganda are highlighted and conclusions drawn regarding the development of future services.
    • Issues of Ageing, Social Class, and Poverty

      Carey, Malcolm (Routledge, 2019-01-18)
      This chapter examines some ethical and political challenges generated by the increasingly complex needs of an ageing society upon social work. It concentrates on the UK as a case study and critically evaluates related age-graded policies and practices relating to social work and care. The chapter includes a discussion of the on-going ethical tensions between social diversity within an ageing society and the shrinking of formal care provision.
    • “It’s a Tug of War Between the Person I Used To Be and the Person I Want To Be” The Terror, Complexity, and Limits of Leaving Crime Behind

      Buck, Gillian; University of Chester (SAGE, 2016-12-20)
      This article draws upon an ethnographic study of peer mentoring in the United Kingdom criminal justice system. It examines how people attempting to desist from criminal lifestyles often experience a period of crisis, characterized by unsettling practical and personal losses. Through interviews with peer mentors and mentees, and observations of mentoring practices, this study renders this sense of adversity visible. It also reveals the ways in which peer mentors may alleviate the weight of the crisis, by providing a blueprint of change, while appearing to be nonauthoritarian. These are important components given that mentees often feel untethered from known ways of being and describe their interactions with authority figures as embattled. An interesting secondary effect which emerges here is that peer mentors appear to shift the perceptions of external observers. This is a vital feature, given that sustained desistance from crime requires contexts conducive to such changes.
    • ‘It’s more than confusing our b’s and d’s’: a commentary on the lack of understanding of the needs of social work students who have dyslexia

      Gant, Valerie; Hewson, Michael; University of Chester
      Drawing on principles of auto-ethnography, this commentary offers for discussion reflections on a personal reaction to some of the struggles experienced when navigating the English social work placement landscape for a student who has a diagnosis (or label) of dyslexia/dyspraxia. Commenting on some of the challenges faced in order to try and survive the placement experience necessary to complete the programme, this account makes recommendations and suggestions for educators in university and in practice.